2007 Zimmerman tl CITY OF BOYNTON BEACH
AOVISSO'I Y! bARD APPOINTMENT APPLICATION
Er Y ~d 2001 DEr
I Dm Thank you for your interest in-ssrving4czt dvisory board and for taking the time to fill out this form.
Please print or type all answers c)early. If interest is expressed in appointment to more than one board, selections must be
prioritized. If instructions are not Riecb'rrthq 9,pcataon is not filled out in its entirety, the form will be returned for clarification.
Name I I 7 — t e /1 CL. 1/1
Address gif S . W '�*4-- vc
I S - >
City eDYN( t r State FL Zip Code 3;3'ii---2(�
E-mail Address I
Current occupation or, if retired, prior occupation (let-�/{(v _ A V I)j ; (Z - . '-' $ l ti E P.
Education I ;-,
Are you a registered voter? Yes1 C' No a -<cs
Do you reside within the Boynton Beach City limits? (-61C' No
Do you own/manage a business within City limits? C Yes Nom 3 z
1/49 -7-1103
If"yes", name of business: I
D, a W n
C t D C�'� ri,
1/ S a i/LS of-2 M
Are you currently serving on a City board? Yes, C' No �� / (:A his
Have you served on a City board in the past? ' C`No
If so,which board(s)and when? ,13(/i I-D 1 N& i3 0/A Al) of A b i J.5 1M '41 t i'it:jt/4574,
Have you ever been convicted of a crime? C Yes No)
If so, when? Where?
f icuj'L"rreitwwte(by number tvtic.'r AAS:Y.A,�-i f P- (c)you are 5_,•=0 ^^ r ^r±_vy_'.,,ay cry .,nom^.ly one board.
Please do not check more than three boards. Prioritize your choices by number, 1 being the most desired and 3 being the least preferable.
For board requirements,responsibilities and meeting times and dates,see the attached listing.
Arts Commission Firefighters' Pension Trust Fund
Building Board of Adjustment&Appeals Golf Course Advisory Committee
Cemetery Board Library Board
Code Compliance Board Planning & Development Board r
Community Redevelopment Agency* Police Officers' Retirement Trust Fund '
Community Relations Board Recreation & Parks Board -73
Education and Youth Advisory Board Senior Advisory Board
Employees' Pension Board X Veterans Advisory Commission** Cfl
CT
* Resume required
** List Branch of Military Service or Organization on Reverse Side.
What personal qualifications do you possess (i.e., profession, previous experience, branch of military service or organization)which
you feel would make you a good candidate for this board? Please be specific.
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First Choice:
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Second Choice: V u'
Third Choice:
Ifir
Feel free to attach an extra sheet or resume. Return the completed form to:
City Clerk's Office, -100 ast EsoyrttarrBeactrBOuievarct7Cttytiail. iJiaiiing add'ebb. P.O. BOA 3 i0, Boynton Beach;-Ft-33425-03 i0
FAX to: (561)742-6090
It will be placed in the City's Talent Bank, a file to which Commissioners may turn for candidates when board openings occur.
I hereby certify that the statements and answers provided herein are true and accurate. I understand that, if appointed, any false
statements may be cause for removal from a board.
Signature: 2 Date: / / Y/Q 7
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